Necrobiosis Lipoidica: An Exquisite Analysis of its Pathogenesis, Clinical Presentation, and Current Therapeutic Approaches

Main Article Content

Laura Yoana Cervantes Ramírez
Aldo Sinue Cruz González
Cesar Made Padilla
Alan Eduardo Garzón Navarrete
Adriana Yazmín Ramos Ramírez
María Fernanda Aguilar Orozco

Abstract

Necrobiosis lipoidica (NL) is a rare dermatologic disease of uncertain origin characterized by the appearance of chronic, deep cutaneous lesions, predominantly on the legs of patients with type 1 diabetes mellitus. This article comprehensively addresses NL, exploring its intricate pathogenesis, clinical manifestations, and current therapeutic options.


NL has become a clinical challenge due to its chronic and often refractory nature. Its connection with type 1 diabetes mellitus and the possible contribution of autoimmune factors in its development are highlighted. In addition, theories involving inflammation, microangiopathy, and collagen disruption as key components of its pathogenesis are discussed.


The clinical presentation of NL is varied, ranging from well-demarcated erythematous plaques to painful and disfiguring ulcers. Differential diagnoses are meticulously addressed, and imaging techniques and skin biopsies are described as essential tools in diagnostic confirmation.


In terms of therapeutic options, pharmacological approaches such as topical corticosteroids, immunomodulators, and emerging biologic therapies are discussed. The efficacy and safety of these options are critically evaluated, highlighting the need for a personalized approach for each patient.


In summary, this article provides a comprehensive overview of necrobiosis lipoidica, from its underlying mechanisms to currently available treatment strategies. A thorough understanding of this clinical entity is essential to improve the quality of life of affected patients and to advance the search for more effective therapies in the future.

Article Details

How to Cite
Laura Yoana Cervantes Ramírez, Aldo Sinue Cruz González, Cesar Made Padilla, Alan Eduardo Garzón Navarrete, Adriana Yazmín Ramos Ramírez, & María Fernanda Aguilar Orozco. (2023). Necrobiosis Lipoidica: An Exquisite Analysis of its Pathogenesis, Clinical Presentation, and Current Therapeutic Approaches. International Journal of Medical Science and Clinical Research Studies, 3(9), 2108–2111. https://doi.org/10.47191/ijmscrs/v3-i9-54
Section
Articles

References

I. Muller SA, Winkelmann RK. Necrobiosis lipoidica diabeticorum. A clinical and pathological investigation of 171 cases. Arch Dermatol. 1966;93(3):272-81.

II. Erfurt-Berge C, Seitz AT, Rehse C, Wollina U, Schwede K, Renner R. Update on clinical and laboratory features in necrobiosis lipoidica: a retrospective multicentre study of 52 patients. Eur J Dermatol. 2012;22(6):770-5.

III. Engel MF, Smith JG Jr. The pathogenesis of necrobiosis lipoidica. Necrobiosis lipoidica, a form fruste of diabetes mellitus. Arch Dermatol. 1960;82:791-7.

IV. Ngo B, Wigington G, Hayes K, Huerter C, Hillman B, Adler M, et al. Skin blood flow in necrobiosis lipoidica diabeticorum. Int J Dermatol. 2008;47(4):354-8.

V. O'Toole EA, Kennedy U, Nolan JJ, Young MM, Rogers S, Barnes L. Necrobiosis lipoidica: only a minority of patients have diabetes mellitus. Br J Dermatol. 1999;140(2):283-6.

VI. 6.Marcoval J, Gómez-Armayones S, Valentí-Medina F, BonfillOrtí M, Martínez-Molina L. Necrobiosis lipoidica: a descriptive study of 35 cases. Actas Dermosifiliogr. 2015;106(5): 402-7.

VII. Kelly WF, Nicholas J, Adams J, Mahmood R. Necrobiosis lipoidica diabeticorum: association with background retinopathy, smoking, and proteinuria. A case controlled study. Diabet Med. 1993;10(8):725-8.

VIII. Lowitt MH, Dover JS. Necrobiosis lipoidica. J Am Acad Der matol. 1991;25(5 Pt 1):735-48.

IX. Burillo-Martínez S, Maroñas-Jiménez L, Morales-Raya C, Gutiérrez García-Rodrigo C, Postigo-Llorente C, Rodríguez-Peralto JL. Necrobiosis lipoidica of the glans penis: a case report and literature review. J Dtsch Dermatol Ges. 2016; 14(10):1040-1.

X. Patel GK, Harding KG, Mills CM. Severe disabling Köebnerizing ulcerated necrobiosis lipoidica successfully managed with topical PUVA. Br J Dermatol. 2000;143(3):668-9.

XI. Reid SD, Ladizinski B, Lee K, Baibergenova A, Alavi A. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options. J Am Acad Dermatol. 2013;69(5):783-91.

XII. Santos-Juanes J, Galache C, Curto JR, Carrasco MP, Ribas A, Sánchez del Río J. Squamous cell carcinoma arising in longstanding necrobiosis lipoidica. J Eur Acad Dermatol Venereol. 2004;18(2):199-200.

XIII. García-Gavín J, Comba Pérez-Pérez L, Requena L, Wortsman X.Sarcoidal necrobiosis lipoidica in a nondiabetic patient: usefulness of skin ultrasound. Actas Dermosifiliogr. 2016;107(6): 525-7.

XIV. Conde-Montero E, Avilés-Izquierdo JA, Mendoza-Cembranos MD, Parra-Blanco V. Dermoscopy of necrobiosis lipoidica. Actas Dermosifiliogr. 2013;104(6):534-7.

XV. Herrera Ceballos E, Moreno Carazo A, Requena Caballero L, Rodríguez Peralto JL. Dermatopathology: clinicopathologic correlation. 1st ed. Madrid: Área Científica Menarini; 2007.

XVI. Lallas A, Zaballos P, Zalaudek I, Apalla Z, Gourhant JY, Longo C, et al. Dermoscopic patterns of granuloma annulare and necrobiosis lipoidica. Clin Exp Dermatol. 2013;38(4):425-7.

XVII. Chiba T, Takahara M, Nakahara T, Fukagawa S, Takei K, Shono A, et al. Cutaneous sarcoidosis clinically mimicking necrobiosis lipoidica in a patient with systemic sarcoidosis. Ann Dermatol. 2012;24(1):74-6.